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New York's Next Health Care Revolution: How Public and Private Employers Can Empower Patients and Consumers

Introduction

Health care policy debates often center on the role of the federal government, but New York and the other states also have important roles to play under the Affordable Care Act (ACA). In many of the areas discussed in the subsequent chapters of this volume—transparency, competition, regulation, licensing, safety—state policy can assume a primary role in driving innovation.

New York has considerable advantages: leading hospitals, medical schools, and research centers; world-class physicians; extensive public-health facilities; and major health care foundations. Wall Street can finance innovative health care firms. The state is home to some of America's leading employers, who have experimented for decades with tools to "bend the curve" of health care spending. And New York's government employs some 250,000 people,[1] affording it huge leverage to mold provider practices.

Despite such strengths, New York's health care system, like that of other states, does not provide the information on safety and quality necessary for consumer-driven health care to succeed. Failure to reform will hurt patients (particularly the poorest and sickest), taxpayers, and New York's economy. In New York's Next Health Care Revolution: How Public and Private Employers Can Empower Patients and Consumers, five distinguished experts from academia, business, and the not-for-profit world identify New York's major hurdles to reform—and propose solutions to overcome them.

In Chapter 1, Laurel Pickering, president and CEO of the Northeast Business Group on Health, highlights the most distinctive features of New York's current health care market. In Chapter 2, Joseph Antos, Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, examines how limited competition between providers produces mediocre health outcomes in the Empire State. In Chapter 3, Leah Binder, president and CEO of the Leapfrog Group, details the frightening scarcity of publicly available information on provider safety. In Chapter 4, Mario Schlosser, cofounder and CEO of Oscar Health Insurance, explains how technology can transform New York's health care outcomes. And in Chapter 5, Robert Moffit, senior fellow at the Heritage Foundation's Center for Health Policy Studies, discusses the untapped potential of private health-insurance exchanges. Their recommendations for reform share fundamental objectives:

Simplify health care for patients by making it easier to make better choices.

Liberate the data that allow patients, employers, providers, and plans to identity the safest, most effective providers and treatments.

Use competition as a platform to drive disruptive innovations in health care reimbursement and delivery systems—to boost economic growth and ensure that New York's economy and health care system thrive in the twenty-first century.

Patients' engagement (i.e., appetite for consumerism) will, of course, vary by health status and socioeconomic factors. Our suggested reforms will not, in other words, apply equally to all patients at all times. For the Medicaid population, particularly those with serious mental illnesses or developmental challenges, and the disabled elderly, policymakers will likely need to consider a different set of interventions to maximize outcomes and produce better value.

Yet embracing transparency and competition across the health care system—thereby engaging the median "patient-consumer," as well as the vast majority of employed New Yorkers—will produce spillover benefits for populations with chronic diseases. Better data on health outcomes will help patients identify the best providers for their needs, especially as value-based benefit designs, tiered networks, and reimbursement contracts that reward high value providers become more common. In fact, patients suffering chronic diseases have the most to benefit from a truly patient-focused, value-driven health care system.